"The thing about the bully pulpit is that Presidents can make the most fantastic claims and it takes days to sort the reality from the myths. So as a public service, let's try to navigate the, er, remarkable Medicare discussion that President Obama delivered on Wednesday. It isn't easy.

Mr. Obama began by depicting a crisis in the entitlement state, noting that "our health-care system is placing an unsustainable burden on taxpayers," especially Medicare. Unless we find a way to cauterize this fiscal hemorrhage, "we will eventually be spending more on Medicare than every other government program combined. Put simply, our health-care program is our deficit problem. Nothing else even comes close."

On this score he's right. Medicare's unfunded liability—the gap between revenues and promised benefits—is currently some $37 trillion over the next 75 years. Yet the President uses this insolvency as an argument to justify the creation of another health-care entitlement, this time for most everyone under age 65. It's like a variation on the old Marx Brothers routine: "The soup is terrible and the portions are too small."

As astonishing, Mr. Obama claimed he can finance universal health care without adding "one dime to the deficit, now or in the future, period," in large part by pumping money out of Medicare. The $880 billion Senate plan he all but blessed this week would cut Medicare by as much as $500 billion, mainly by cutting what Mr. Obama called "waste and abuse." Perhaps this is related to the "waste and abuse" that Congresses of both parties have targeted dozens of times without ever cutting it.

Apparently this time Mr. Obama means it, though he said this doesn't mean seniors should listen to "demagoguery and distortion" about Medicare cuts. That's because Medicare is a "sacred trust," and the President swore to "ensure that you—America's seniors—get the benefits you've been promised."

So no cuts, for anyone—except, that is, for the 24% of senior beneficiaries who are enrolled in the Medicare Advantage program, which Democrats want to slash by $177 billion or more because it is run by private companies. Mr. Obama called that money "unwarranted subsidies in Medicare that go to insurance companies—subsidies that do everything to pad their profits but don't improve the care of seniors."

In fact, Advantage does provide better care, which is one reason that enrollment has doubled since 2003. It's true that the program could be better designed, with more competitive bidding and quality bonuses. But Advantage's private insurers today provide the kind of care that Mr. Obama said he would mandate that private insurers provide for the nonelderly—"to cover, with no extra charge, routine checkups and preventative care."

Advantage plans have excelled at filling in the gaps of the a la carte medicine of traditional Medicare, contracting with doctors and hospitals to coordinate care and improve quality and covering items such as vision, hearing and management of chronic illness. If seniors in Advantage lose this coverage because of the 14% or 15% budget cut that Mr. Obama favors, well, that's "waste and abuse."

Mr. Obama did also promise to create "an independent commission of doctors and medical experts charged with identifying more waste in the years ahead." That kind of board is precisely what has many of the elderly worried about government rationing of treatment: As ever-more health costs are financed by taxpayers, something will eventually have to give on care the way it has in every other state-run system.

But Mr. Obama told seniors not to pay attention to "those scary stories about how your benefits will be cut, especially since some of the folks who are spreading these tall tales have fought against Medicare in the past and just this year supported a budget that would essentially have turned Medicare into a privatized voucher program."

This is a partisan swipe at one of the best GOP ideas to rationalize the federal budget, despite Mr. Obama's accusations that his opponents want to do "nothing." This reform would get Medicare out of the business of spending one out of five U.S. health dollars, and instead give the money directly to seniors to buy insurance to encourage them to be more conscious of cost and value within a limited budget. Democrats would rather have seniors dance to decisions made by his unelected "commission of doctors and medical experts."

Mr. Obama also called for "civility" in debate even as he calls the arguments of his critics "lies." So in the spirit of civility, we won't accuse the President of lying about Medicare. We'll just say his claims bear little relation to anything true."

Buzz

09-11-2009, 12:24 PM

Facts? From the Opinion page of the WSJ!

It's more like a love letter to the private insurance companies.

This is my personal favorite:

"This reform would get Medicare out of the business of spending one out of five U.S. health dollars, and instead give the money directly to seniors to buy insurance to encourage them to be more conscious of cost and value within a limited budget."

Sounds like rationing to me, except seniors will be deciding to forgo treatment on their own, because they can't afford it...

TXduckdog

09-11-2009, 02:00 PM

And what the hell is wrong with giving money directly to seniors to acquire their own insurance.

Where the hell do you get the idea this has anything to do with rationing?

For that matter...where is there one mention of private insurance companies?

How do you invent this stuff?

Buzz

09-11-2009, 03:24 PM

Where the hell do you get the idea this has anything to do with rationing?

For that matter...where is there one mention of private insurance companies?

How do you invent this stuff?

Because from the quote I cited, I can put 2 and 2 together.

I happen to know that Republicans were proposing to shut down medicare completely and give vouchers to seniors to put toward buying their own insurance coverage from private insurance companies. Further the quote states:

"to buy insurance to encourage them to be more conscious of cost and value within a limited budget."

Maybe you can tell me exactly what this means. I work with a few seniors, I'll ask them what they think it means.:confused: One of them is 71, the other is 86. One has as diabetes and had a minor stroke. The other has high blood pressure. I wonder what private insurance would want for premiums to cover them?

ducknwork

09-11-2009, 04:11 PM

Gotta agree with Buzz on this one. The govt would undoubtedly not give seniors enough money to afford the coverage that they need and still lower costs.

On the other hand, if seniors received X amount per month to pay their premium, there could be a private insurance company that, knowing what X amount is, offer the necessary insurance at a reasonable rate.
________
Chevrolet nova (http://www.chevy-wiki.com/wiki/Chevrolet_Nova)

Gerry Clinchy

09-11-2009, 08:29 PM

Unfortunately, the hypothesis of having people buy their own health insurance and plan for their own retirements voluntarily didn't work in the past ... and that was at least one of the factors that caused SS and Medicare to come into being.

Just like the young people often discussed in this whole health care scenario. For those in lower income brackets the cost of the insurance or retirement planning becomes a higher percentage of their income, and some (many?) simply don't plan for a "rainy day". So, SS and Medicare payroll deductions "forced" everyone to put something aside for the inevitable "rainy days" of senior years.

Unfortunately, legislators were no better at planning. When they saw the attractive reserves building up, they borrowed from SS funding for the general budget and/or added benefits. Same for Medicare.

Thus, maybe there is a need for "compulsory" saving from each citizen. However, there should be a way to have those funds set aside away from the legislators' ability to touch them.

IRAs were one partial concession to giving an incentive for adding to SS retirement benefits. Possibly the error there was not allowing deductions for IRAs if an employer pension plan existed, and limiting deductions for IRAs for those who did not have pension plans. By giving an incentive for more aggressive retirement saving, more of the elderly would have been able to afford some/more/better health insurance in their later years, with Medicare and SS not carrying the entire burden. Maybe even a voucher system, whereby valid retirement savings were rewarded by a tax refund? I think it's human nature to deal with immediate needs before thinking of planning for the "rainy day". That is easier for those with an income level that provides for more "disposable" income. Less easy when the "disposable" income each month is minimal.

As a Realtor® I enter homes of people of all income levels. I don't own a big-screen TV (and now our electric company tells us that an LCD TV uses 2X the electricity of the old-fashioned kind; a plasma TV uses 3X as much energy!) ... yet I have seen large screen TVs (I can't tell LCD from plasma, so don't ask me which) in the rental units of people getting Sec. 8 housing subsidies. The point here being that people with less disposable income may first spend it on things that make them feel better now, not long-term planning.

So maybe mandatory health and retirement planning is not an outlandish idea. However, there should be a way that individuals can assure that their savings will not be usurped. Perhaps it is even possible that if there were some kind of a tax refund incentive individuals would be better able to see that they are getting a direct benefit from their thrift and long-term planning?

I don't think I'm the genius who can come up with "how" this could be implemented, but I think there is something of value in an incentive concept.

Medicare is the ultimate cherry-picking opportunity for private insurors. They rid themselves of the catastrophic liabilities, and provide the "gap" coverage. I'm almost surprised to see private insurors lobbying against being able to limit themselves to the higher-profit sectors of health insurance that would be their "fit" in a public insurance option.

Of course, I think they wouldn't need as many employees, so it would cost thousands of jobs in the insurance sector of the economy. Some of those jobs, at least, would then become government jobs to administer the public option program. Those workers would then be able to get into that very cushy Federal employee retirement/health care program. Wonder if COB included that added cost for those new Federal employees' benefits in their calculations?

Buzz

09-11-2009, 08:46 PM

Gerry, that was the most reasonable post I've seen in awhile.

By the way, I have 2 big screen TV's, but I think I can afford them.

They cost a hell of a lot less than my field trial dogs do...

Gerry Clinchy

09-11-2009, 09:10 PM

Buzz

They cost a hell of a lot less than my field trial dogs do...

A quote that nobody on this board could dispute! :-)

dnf777

09-12-2009, 07:35 AM

I heard that the big insurance companies give 29% of their total outflow to administrative costs. Medicare 0.9%. And I hear the gov't is inefficient?

Gerry Clinchy

09-12-2009, 08:16 AM

I heard that the big insurance companies give 29% of their total outflow to administrative costs. Medicare 0.9%. And I hear the gov't is inefficient?

There might be differences in the way those costs are computed?

For example, the private insuror would likely be including the salaries and benefits of top executives in their administrative costs. However, with government, there might not be an apportionment of the salaries and benefits of our legislators and other administrative officials (like Sec of Health, etc). who certainly do spend some of their time either making and/or implementing the attendant regulations that apply to Medicare. I would call those administrative costs as well as those directly processing the claims submitted.